NEWSROOM

A new California law is about to make infertility coverage – including IVF (in vitro fertilization) – a standard benefit in fully insured Large Group plans. SB 729, signed into law by Governor Newsom in 2024, requires plans issued, amended, or renewed on or after July 1, 2025, to include coverage for the diagnosis and treatment of infertility. This includes IVF and related services that were previously considered optional or add-on benefits in many plans.
 
It also requires insurers in the Small Group market to make at least one plan available that includes the same level of infertility coverage required for Large Group plans, also effective July 1, 2025.
 
The law applies to fully insured health plans regulated by either the California Department of Insurance (CDI) or the Department of Managed Health Care (DMHC). It does not apply to self-funded or level-funded plans, which fall outside the state’s regulatory purview.

What’s Required for California Large Group Plans

For California Large Group plans – those available to employers with 101 or more employees – the mandate is clear: coverage for infertility treatment must be included in all plans. That coverage must include standard diagnostic testing and services such as artificial insemination, IVF, GIFT, and ZIFT. The law also requires up to three oocyte retrieval cycles per lifetime and unlimited embryo transfers, along with any medically necessary prescription drugs and related care.
 
Cost-sharing for these services is treated like any other covered benefit, with standard copays and coinsurance applying based on the plan’s structure. Importantly, the law prohibits any lifetime or annual dollar limits on infertility coverage and requires that benefits be delivered without discrimination based on gender, relationship status, sexual orientation, or similar factors.

Small Group Plans Must Offer, But Not Include

In the Small Group market, SB 729 does not require every plan to include infertility and IVF benefits by default. Instead, it requires carriers to offer at least one plan that includes comprehensive infertility coverage – meaning the benefit must be available in the market, even though employers are not required to select or offer that plan to their employees.
 
Any plan that does include infertility coverage must follow the same benefit requirements as Large Group plans – covering medically necessary diagnosis and treatment of infertility, including IVF and unlimited embryo transfers.

Definition of “Infertility” in SB 729

In addition to requiring coverage for artificial insemination, IVF, GIFT, ZIFT, up to three oocyte retrieval cycles per lifetime, and unlimited embryo transfers, the law also broadens the clinical definition of infertility.
 
Under SB 729, infertility includes a physician’s diagnosis based on medical, sexual, or reproductive history, as well as the inability to conceive after 12 months of regular unprotected intercourse – or six months if the individual is over age 35. It also includes individuals who cannot reproduce without medical intervention or who experience repeated miscarriages.

No Impact on Level-Funded and Self-Funded Plans

SB 729 does not apply to self-funded or level-funded plans. These arrangements are governed by federal ERISA law only and are not subject to the state-mandated insurance requirements enforced by CDI and DMHC.
 
That means carriers offering level-funded plans – even those operating in California – are not required to comply with this new mandate.
 
However, we may soon start to see ripple effects, particularly if fully insured carriers begin to standardize infertility coverage more broadly across their portfolios. This shift could shape plan expectations and increase pressure on self-funded or level-funded employers to voluntarily match what’s becoming the new norm in California’s fully insured Large Group market. Still, it’s important to remember that state insurance mandates do not apply to Self-Funded or Level-Funded arrangements.

Additional Exemptions

The law explicitly exempts plans sponsored by religious employers, as well as coverage offered through Medi-Cal, Medicare, or CalPERS – although CalPERS will be required to comply starting in July 2027.

Final Thoughts

SB 729 is one of the most robust state mandates for infertility coverage in the country. For fully insured Large Group clients, it makes comprehensive IVF coverage non-negotiable when those plans are issued, amended, or renewed beginning July 1, 2025. For Small Group employers, it introduces a new layer of decision-making and carrier comparison. And for those in the self-funded or level-funded space, it may signal a shift in market expectations – even without a formal requirement to change.
 
With July 2025 just around the corner, now is the time to understand how this new law fits into your clients’ renewal strategy and benefit offerings.